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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 488 (January 27, 2024).

55 Pa. Code § 1101.65. Method of payment.

§ 1101.65. Method of payment.

 The Department makes direct payments to enrolled providers for medically necessary compensable services and items furnished to eligible recipients. The MA Program does not reimburse recipients for their expenditures. To be reimbursed for an item or service, the provider shall be eligible to provide it on the date it is provided, and the recipient shall be eligible to receive it on the date it is furnished unless there is specific provision for such payment in the provider regulations. Providers are prohibited from factoring, assigning, reassigning or executing a power of attorney for the rights to any claims or payments for services rendered under the program except as provided in paragraphs (1) and (3).

   (1)  Reassignment of payment. The Department will not make payment to a collection agency or a service bureau to which a provider has assigned his accounts receivable; however, payment may be made if the provider has reassigned his claim to a government agency or the reassignment is by a court order.

   (2)  Payment through business agents. The Department will not make payment to a provider through a billing service or accounting firm that receives payment in the name of the provider.

   (3)  Payment through employers. Payment may be made to practitioners’ professional corporations or partnerships if the professional corporation or partnership is composed of like practitioners. Payment is made directly to practitioners if they are members of professional corporations or partnerships composed of unlike practitioners. The Department will not make payment to a shared health facility for services rendered by a practitioner practicing at the shared health facility.


   The provisions of this §  1101.65 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 3653. Immediately preceding text appears at serial pages (75058) and (75059).

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